A national study of choanal atresia in tertiary care centers in Canada - part II: clinical management

Josee Paradis; Agnieszka Dzioba; Hamdy El-Hakim; Paul Hong; Frederick K Kozak; Lily H P Nguyen; Demitri Perera; Evan Jon Propst; Jennifer M Siu; Monika Wojtera; Murad Husein; National Choanal Atresia Study Working Group

doi:10.1186/s40463-021-00503-3

A national study of choanal atresia in tertiary care centers in Canada - part II: clinical management

J Otolaryngol Head Neck Surg. 2021 Jul 13;50(1):46. doi: 10.1186/s40463-021-00503-3.

Authors

Josee Paradis^{1

2}, Agnieszka Dzioba³, Hamdy El-Hakim⁴, Paul Hong^{5

6}, Frederick K Kozak^{7

8}, Lily H P Nguyen^{9

10

11}, Demitri Perera¹², Evan Jon Propst¹³, Jennifer M Siu¹³, Monika Wojtera¹⁴, Murad Husein^{3

14}; National Choanal Atresia Study Working Group

Affiliations

¹ Department of Paediatric Otolaryngology- Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, London, ON, Canada. [email protected].
² Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. [email protected].
³ Department of Paediatric Otolaryngology- Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, London, ON, Canada.
⁴ Division of Pediatric Surgery and Otolaryngology Head and Neck Surgery, Departments of Surgery and Pediatrics, The Stollery Children's Hospital, University of Alberta Hospital, Edmonton, AB, Canada.
⁵ IWK Health Centre, Halifax, NS, Canada.
⁶ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
⁷ Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁸ Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, BC, Canada.
⁹ Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada.
¹⁰ Institute for Health Science Education, McGill University, Montreal, Canada.
¹¹ Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada.
¹² Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
¹³ Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
¹⁴ Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.

Abstract

Background: To evaluate the clinical management of choanal atresia (CA) in tertiary centers across Canada.

Methods: Multi-centre case series involving six tertiary care pediatric hospitals across Canada. Retrospective chart review of patients born between 1980 and 2010 diagnosed with choanal atresia to a participating center.

Results: The health charts of 215 patients (59.6% female) with choanal atresia (CA) were reviewed. Mean age of initial surgical repair was 0.8 months for bilateral CA, and 48.6 months for unilateral CA. Approaches of surgical repair consisted of endoscopic transnasal (31.7%), non-endoscopic transnasal (42.6%), and transpalatal (25.2%). Stents were used on 70.7% of patients. Forty-nine percent of patients were brought back to the OR for a planned second look; stent removal being the most common reason (86.4%). Surgical success rate of initial surgeries was 54.1%. Surgical technique was not associated with rate of restenosis [χ² (2) = 1.6, p = .46].

Conclusions: The present study is the first national multi-institutional study exploring the surgical outcomes of CA over a 30-year period. The surgical repair of CA presents a challenge to otolaryngologists, as the rate of surgical failure is high. The optimal surgical approach, age at surgical repair, use of stents, surgical adjuncts, and need for planned second look warrant further investigation.

Keywords: Choanal atresia; Planned second look; Post-operative management; Surgical adjuncts; Surgical repair.

Publication types

Multicenter Study

MeSH terms

Child
Choanal Atresia* / epidemiology
Choanal Atresia* / surgery
Endoscopy
Female
Humans
Infant, Newborn
Male
Retrospective Studies
Tertiary Care Centers
Treatment Outcome